January 14, 2013
The Vice President
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500
Dear Mr. Vice President:
I write to bring to your attention critical recommendations on behalf of the National Council on Disability (NCD), an independent federal agency comprised of 15 presidential appointees charged with providing advice to the President and Congress on disability policy. NCD applauds your leadership on the gun violence task force because the tragedy of Newtown has touched all of us in a deep and abiding way and decisive action is warranted.
NCD affirms its support for efforts to improve the quality, availability, and affordability of mental health services and supports. NCD also remains concerned about the risk of taking reflexive actions that may appear to be designed to prevent future Newtown tragedies but have other unintended and undesirable consequences in worsening rather than improving access to mental health services and supports. The principal challenge is that access to mental health services is already compromised by deep and enduring stigma about seeking and receiving mental health treatment. We cannot afford to exacerbate harmful stereotypes about mental illness even as we must act to ensure that all individuals with mental health needs can get help when they need it and help ensure that people who pose significant risks of harming and killing others do not have the opportunity to do so. A basic fact endures: people with psychiatric disabilities are more often the victims of violence than they are the perpetrators of violence. We must recognize the risk of increasing one type of violence while we seek to reduce another type.
Earlier today the Council adopted a series of recommendations during a Special Meeting called specifically to consider recommendations to your task force and review certain legislative and policy proposals that may prove more harmful than beneficial. We urge you to pay careful consideration to these recommendations as you finalize your own recommendations and begin to implement them. As we stated at the creation of your task force, NCD remains willing to work with you and your staff as the work of your task force unfolds.
First, NCD recommends you develop a framework to invest in community-based mental health supports and programs. Existing federal research reveals a profound shortage of community-based services, including mobile crisis services and peer supports. Community mental health programs can offer excellent, comprehensive services when sufficiently funded and supported. Unfortunately, the severe deficiency in current resources means that these services are often available only to people who are in immediate crisis and who have already endured multiple hospitalizations. Recently, pilot programs have been developed across the country to better meet the needs of people when they have their first psychotic episode. These programs are community-based and help to address critical unmet needs. NCD encourages the Taskforce to advance policy recommendations in line with these models and the principles undergirding them.
Second, NCD urges you to avoid any proposal to link the Social Security Administration's database of representative payees with the FBI's National Instant Criminal Background Check System (NICS). Whatever merits such a proposal might seem to present, such benefits are outweighed by the inaccurate and discriminatory inference that would result: equating the need for assistance in managing one's finances with a presumption of incapacity in other areas of life. Maximizing self-direction is critical to enabling people with disabilities to meet the goals of the ADA: equality of opportunity, full participation, independent living, and economic self-sufficiency. Many people with disabilities and seniors rely on representative payees as a practical measure to facilitate income support. There should not be any permissible inference that use of a representative payee signals impairment of decision-making—whether it be in casting votes or choosing health care providers. Linking the representative payee system and the NICS would support just such an inference. NCD recommends you ensure that the selection of a representative payee continues to have no implication on other areas of rights beyond financial decision-making.
Third, NCD urges you to avoid any proposal comparable to the provision of S. 436, the Fix Gun Checks Act, which amends the Higher Education Act to require colleges and universities to outline procedures for the involuntary referrals of students with perceived psychiatric disabilities for evaluation and institutionalization. As set forth in its first recommendation, NCD maintains that enhanced access to mental health services and supports is critical. We also understand that current law properly requires that knowledge of an immediate threat to safety is reported and addressed. However, a policy that broadly targets individuals who have not exhibited a threat of harm risks increasing discrimination and stigmatization for college students and could have the chilling effect of discouraging students from seeking the very mental health services they need in times of distress. Universities across the country are making progress with mental health programs on campus and are showing positive results. NCD supports increased opportunity for peer-to-peer support and campus-based counseling programs, and encourages campus policies that focus on making these resources more broadly available.
Finally, NCD urges you to ensure that identification and isolation of individuals who have harmed others or are at risk of committing acts of violence does not lead to unnecessary expansion in institutionalization, involuntary commitment and forced treatment for individuals who may benefit from mental health services and supports but pose no risk of violence and have a basic human right to make independent decisions. There is no current system capable of reliably identifying persons who are likely to become dangerous, and there is not established correlation between psychiatric diagnosis and violent behavior. Federal legislation calling for forced medication or treatment would restrict the fundamental civil rights of people with psychiatric disabilities. Incarcerating individuals for punishment of crimes committed is central to our criminal justice system. But incarceration and forced treatment of stigmatized individuals based on misplaced fears and stereotypes has no place in our civil society. Institutional care has a long-standing history of poor outcomes and civil rights violation among persons with psychiatric disabilities.
Thank you for your thoughtful consideration of NCD’s recommendations. We remain ready to assist and advise your task force, the Administration, and leaders of Congress to best meet the health, safety and security needs of the American public, including Americans with psychiatric disabilities.
Jonathan M. Young, PhD, JD
Chairman, National Council on Disability